Risk of Incident Atrial Fibrillation and Subsequent Use of Oral Anticoagulants in Patients with Dementia.

IF 5 2区医学 Q1 HEMATOLOGY Thrombosis and haemostasis Pub Date : 2024-03-01 Epub Date: 2023-09-30 DOI:10.1055/a-2184-7506

Chuan-Tsai Tsai, Yi-Hsin Chan, Jo-Nan Liao, Tzeng-Ji Chen, Gregory Y H Lip, Shih-Ann Chen, Tze-Fan Chao

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Abstract

Background: Dementia and atrial fibrillation (AF) have many shared risk factors. Besides, patients with dementia are under-represented in randomized trials, and even if AF is present, oral anticoagulants (OACs) are not prescribed frequently. This study aimed to report the incidence of newly diagnosed AF in dementia patients, and the impacts of use of vitamin K antagonist (VKA; e.g., warfarin) and non-VKA OAC (NOACs) on stroke and bleeding outcomes.

Methods: Our study utilized the Taiwan National Health Insurance Research Database. A total of 554,074 patients with dementia were compared with 554,074 age- and sex-matched patients without dementia regarding the risk of incident AF. Among patients with dementia who experienced incident AF, the risks of clinical events of patients treated with warfarin or NOACs were compared with those without OACs (reference group).

Results: The risk of incident AF was greater for patients with dementia compared with those without (adjusted hazard ratio [aHR]: 1.054; 95% confidence interval [CI]: 1.040-1.068 for all types of dementia, aHR: 1.035; 95% CI: 1.020-1.051 for presenile/senile dementia, and aHR: 1.125; 95% CI: 1.091-1.159 for vascular dementia). Among patients with dementia and experienced incident AF, warfarin use was associated with a higher risk of ischemic stroke (aHR: 1.290; 95% CI: 1.156-1.440), intracranial hemorrhage (ICH; aHR: 1.678; 95% CI: 1.346-2.090), and major bleeding (aHR: 1.192; 95% CI: 1.073-1.323) compared with non-OACs. NOAC use was associated with a lower risk of ischemic stroke (aHR: 0.421; 95% CI: 0.352-0.503) and composite risk of ischemic stroke or major bleeding (aHR: 0.544; 95% CI: 0.487-0.608) compared with non-OACs. These results were consistent among the patients after the propensity matching.

Conclusion: In this large nationwide cohort, the risk of newly diagnosed AF was higher in patients with dementia (all dementia, presenile/senile dementia, and vascular dementia) compared with those without dementia. For patients with dementia who experienced incident AF, NOAC use was associated with a better clinical outcome compared with non-OAC. Patients with dementia require a holistic approach to their care and management, including the use of NOACs to reduce the risks of clinical events.

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痴呆患者发生心房颤动的风险及随后口服抗凝剂的使用。

背景：痴呆和心房颤动有许多共同的危险因素。关于痴呆患者发生房颤的风险和房颤相关临床结果的数据有限。方法：利用台湾国民健康保险研究数据库进行实证研究。就发生房颤的风险而言，共有544074名痴呆症患者与554074名年龄和性别匹配的无痴呆症患者进行了比较。在经历过房颤的痴呆症患者中，将接受华法林或NOAC治疗的患者与未接受OAC治疗的患者的临床事件风险进行比较。结果：痴呆症患者发生房颤的风险高于无痴呆症患者（每100人-年1.89 vs 1.78）。与非OAC相比，在患有痴呆和经历AF事件的患者中，使用华法林与缺血性卒中（aHR 1.290；95%CI 1.156-1.440）、颅内出血（ICH）（aHR 1.678；95%CI 1.346-2.090）和大出血（aHR 1.192；95%CI 1.073-1.323）的风险更高相关。与非OAC相比，使用NOAC与缺血性卒中的风险较低（aHR 0.421；95%CI 0.352-0.503）和缺血性卒中或大出血的复合风险（aHR 0.544；95%CI 0.487-0.608）相关。这些结果在倾向匹配后的患者中是一致的。结论：在这一全国性队列中，痴呆患者发生房颤的风险更高。对于经历AF事件的痴呆症患者，与非OAC相比，使用NOAC与更好的临床结果相关。痴呆症患者需要一种全面的护理和管理方法，包括使用NOAC来降低临床事件的风险。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Thrombosis and haemostasis 医学-外周血管病

CiteScore

11.90

自引率

9.00%

发文量

140

审稿时长

1 months

期刊介绍： Thrombosis and Haemostasis publishes reports on basic, translational and clinical research dedicated to novel results and highest quality in any area of thrombosis and haemostasis, vascular biology and medicine, inflammation and infection, platelet and leukocyte biology, from genetic, molecular & cellular studies, diagnostic, therapeutic & preventative studies to high-level translational and clinical research. The journal provides position and guideline papers, state-of-the-art papers, expert analysis and commentaries, and dedicated theme issues covering recent developments and key topics in the field.